The Government’s War on Pain Doctors: One Physician’s Story

Editor’s Note: Linda Cheek is a family practice and alternative medicine physician in southwest Virginia. In June, Cheek pleaded not guilty to a 173-count federal indictment accusing her of distributing oxycodone and other painkillers without a valid certificate from the Drug Enforcement Administration. Cheek’s license to practice medicine is currently suspended and she is free on bond. Her trial is scheduled to begin in November.

God always answers prayer. In October, 2010 two hundred of my patients were suddenly without a pain management physician. The U.S. Attorney’s office had coerced the doctor treating pain patients at my office to give up her DEA certificate. Luckily, a doctor was found within 24 hours that agreed to help.

Steven Collins, MD, a family practice physician, agreed to allow me to meet my patients in his office an hour away. He evaluated them after me and continued their treatment.

Dr. Collins graduated in 1995 from Albany Medical College in New York, practiced medicine in the military for three years, and then set up private practice in Roanoke, Virginia. Being very patient oriented, he saw right away that about half of the complaints that bring a patient to a doctor are related to pain. So, like me, he decided to learn how to treat pain so he could take care of his patients. He taught himself, as I did, by going to pain management seminars and meetings of the American Academy of Pain Management.

Dr. Collins’s primary pain management is with opioids, but he also does steroid injections using fluoroscopy. His practice grew into three offices, and he supervised a nurse practitioner and a physician assistant at two sites. He also worked two half days at a methadone clinic in Roanoke, where he was responsible for admissions and discharges. So he has experience and knowledge with methadone prescribing that most physicians lack.

Dr. Collins is comfortable with most opioids, although he typically does not use morphine. Knowledgeable in the rules and procedures with opioid prescribing, he is careful to monitor patients, check drug screens, and watch for the “red flags” of abuse.

But in April this year, Dr. Collins was forced to make a decision that would change his life as well as that of most of his patients. He decided to stop treating pain. This decision was based on a warning he received from a colleague — that he was under investigation by the Virginia State Police.

Dr. Collins immediately worried that he might be arrested with some kind of charge about his treatment of pain patients. One of the common charges against physicians in the government’s war on pain doctors” is “prescribing without justifiable medical purpose.” In these cases, “medical purpose” is defined to be however the U.S. Attorney’s office wants to define it, not how a doctor would define it.

As a solo independent physician with a wife and four children, Dr. Collins couldn’t take a chance with his career. So he sent letters to all of his patients that he would no longer treat pain. This decision caused him to lose 40% of his patient base and, consequently, his income.

When asked what is needed in medicine for doctors to feel secure in practicing pain management, Dr. Collins told me, “We need a written set of guidelines to follow. If the documentation is there, how can we not be treating the patient correctly?”

DEA Harassment

Dr. Collins has had his own experience with government harassment. At one time he provided suboxone therapy for drug abuse. The local DEA agent came to his office to review Dr. Collins’ records.

After three days of being closed and unable to see patients, in frustration Dr. Collins offered to give up his suboxone certification. The DEA agent told him, “Well if you are going to do that, we’ll get out of here.” And they left.

The same agent also appeared one day at Dr. Collins’ office when he was evaluating and treating patients sent from my office. All he had to say to send his message of intimidation was, “We’re watching you.”

It was then that Dr. Collins informed me that he would no longer see my patients.

Dr. Collins is the seventh doctor that I know of in southwest Virginia forced to stop treating pain by the Gestapo tactics of the U.S. Department of Justice. There are probably many more.

Most of the doctors in southwest Virginia don’t treat pain because of fear. Those that do risk getting their medical license or DEA certificate suspended or revoked. A few face criminal charges and most of those accept a plea agreement to avoid a trial or prison sentence.

Having neither money nor fear of prison, but faith in God, I intend to show the world what our Justice Department is all about. My trial is scheduled to start November 5.

Linda Cheek

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I too am a sufferer of chronic pain. I have body wide muscle pain, some degenerative disc changes and I have had my L5-S1 vertebrae fused due to a pars defect. I have too many “trigger points” to count and it is easier to tell my doctor what doesn’t hurt than what does. The pain eventually became debilitating. I finally was able to get on disability (which is not adequate for supporting myself), but not before my home foreclosed. I am college educated and had a decent career, but the pain eventually took over. I was forced to move from Tennessee to Florida where my parents live and I stayed with them for several years until I could get approved for disability. Here in Flordia they are really cracking down and thus far i have been able to keep getting my much needed meds, but not without a struggle. I am allergic to NSAIDs and I cannot take tylenol in even the smallest amounts because it causes my liver numbers to go through the roof. Morphine does not help and causes a terrible side effect of not being able to urinate. The only medication so far I have been able to take is oxycodone, but even now the prescription is not strong enough and my pain is still not being managed well. I feel intimidated and discriminated against to the point of being afraid to tell my doctor my dosage needs to be increased. He is a good doctor and he is frustrated with the state of florida ad how they have limited the amount of opiods a pharmacy can order per month which causes problems as valid prescriptions from reputable doctors are often not being filled. The PDMP (Prescription Drug Monitoring Program) Florida implemented is good in the sense that it does go after “doctor shoppers” by using a data base to find duplicate prescriptions, but it is bad i the sense that putting a limit on pharmacies indiscriminately punishes everyone from the disabled to the person who just had surgery to the terminally-ill. There is very much an environment of intimidation that these doctors feel and patients are feel like they are being treated like drug addicts. This is emotionally traumatizing and patients who suffer with chronic pain are already traumatized on a daily basis as pain leads to depression and generally a lower quality of life. I like you put my faith in God and applaud you for your courage. I will pray for you and I have shared your article here on facebook. God bless you I hope your story gets national attention.

Thank you, Dr. Cheek, for continuing to tell your story, and for exposing the truth about the disgraceful state of pain management in this country for both doctors and patients. I am a chronic pain patient, on long term opioid therapy. If not for this treatment, I would have NO quality of life. I suffer from a connective tissue disorder, called Ehlers-danlos stndrome. (you are one of the FEW doctors, I know, who actually knows what this is!). I have daily chronic pain, from previous recurrent joint dislocations, surgeries, Osteoarthritis, bursitis, degenerative disk disease, as well as daily episodes of severe acute pain from dislocations & subluxations of my hips, SI joints, pelvis, feet, wrists, Jaw, knee caps, shoulders and spine.

People like me, with Intractable pain, who have tried every other method available to treat it, DESERVE to have SOME quality of life, by having our pain managed. It would seem to be common sense, not to let people in serious pain, suffer from constant debilitating pain, when we have medications (opioids) to effectively manage it. WELL…it’s not. Since the DEA, and State and Federal Governemts seem to think they’ve gone to medical school, people like me are suffering horrendously from serious pain conditions.

Instead of going after the “doctor shoppers”, drug dealers, and ” pill mills” (if there are infact, any left), they have decided to make an example out of everyone. Legitimate doctors and pharmacists, and legitimate patients, are suffering, being forced into dangerous withdrawal, getting thrown in jail, threatened, and having their licenses,
livelihoods, and lives taken from them. IT IS INSANE that these rouge actions are governemt sanctioned!

The pendulum has swung TOO FAR in the wrong direction in this so called “WAR in drugs”. It is indeed a WAR on doctors AND the patients who need them. People who have abused these drugs are still getting their “fix”, while the people for whom these drugs were INTENDED, are suffering without proper treatment, or doctors to help them. I’m so sick of hearing that these are ” unintended” consequences. No one really cares about good intentions when they are wrongly accused, thrown in jail, or left to suffer in terrible pain. I hear more stories every week, from people who have been denied pain treatment for serious medical conditions. They are denied by doctors who are afraid of legal repercussions, or by pharmacists who fear the same. This is outright discrimination of the disabled, the elderly, and the sick. Where the hell did the compassion and common sense go? oh yeah…. It’s on TRIAL!!!!!!

Thank you for getting the word out, publicly, about what’s REALLY happening in this WAR. I’m so sorry, Dr. Cheek, that you’ve had to pay such a high price for your compassion for people who suffer. I will be following your case, and will be there in spirit. Shame on our government for allowing people to be TORTURED by their pain, and for persecuting people like you who have tried to help them.